Morton’s toe

Photo of an extreme example of Morton’s toe

A more common example of Morton’s toe

Morton’s Toe (also called “long toe”) is the common term for the condition of a shortened first metatarsal in relation to the second metatarsal. This promotes an anterior position of the second metatarsal-phalangeal (MTP) joint in relation to the Hallux. The condition may or may not result in the second toe (second from innermost) extending farther than the Hallux (big toe).

The name derives from American orthopaedic surgeon Dudley Joy Morton (1884–1960), who originally described it as part of Morton’s triad (a.k.a Morton’s syndrome or Morton’s foot syndrome): a congenital short first metatarsal bone, a hypermobile first metatarsal segment, and calluses under the second and third metatarsals.

Although commonly described as a disorder, it is sufficiently common to be considered a normal variant of foot shape (its prevalence varies with different populations, but around 10% of feet worldwide have this form). The main symptom experienced due to Morton’s toe is discomfort and callusing of the second metatarsal head. This is because the first metatarsal head would normally bear the majority of a person’s body weight during the propulsive phases of gait, but these forces are transferred to the second (smaller) metatarsal head because of its anterior positioning. In shoe-wearing cultures it can be problematic: for instance, in causing nail problems from wearing shoes with a profile that doesn’t accommodate the longer second toe.

It has a long association with disputed anthropological and ethnic interpretations. Morton called it Metatarsus atavicus, considering it an atavism recalling prehuman grasping toes. In statuary and shoe fitting it has been called the Greek foot (as opposed to the Egyptian foot, where the great toe is longer). A longer second toe has often been associated with royalty, particularly during the rule of the Ptolemaic dynasty when Egypt was under Greek rulership. It was an idealized form in Greek sculpture, and this persisted as an aesthetic standard through Roman and Renaissance periods and later (the Statue of Liberty has toes of this proportion). There are also associations found within Celtic groups. The French call it pied ancestral or pied de Néanderthal

Confusion has arisen from the term also sometimes being used for a different condition, Morton’s neuroma, a term coined by Thomas George Morton (1835-1903) for a syndrome involving pain caused by neuroma between the third and fourth toes.

Musculoskeletal dysfunction

Morton’s Toe (MT) as a major perpetuator of musculoskeletal dysfunction and pain.

While the prevalence of MT is less than 50% in the general population, among people suffering from musculoskeletal pain and seeking medical help it is thought to be well over 80%.

The reason MT is often a precursor to musculoskeletal pain is that it is associated with excessive pronation of the foot. When weight bearing, the longitudinal arch of the foot drops, and the ankle rolls inward.

The cause of this motion is that the first metatarsal does not become fully and properly weight bearing until 88% of the contact gait cycle has passed (first ray dorsiflexion McPoil).

The excessive pronation of the foot causes two major postural and functional problems.

The leg is functionally shortened and

the leg is rotated internally. The functionally shortened leg behaves just like a structural short leg. It imbalances the pelvis by dropping one hip lower to the ground. This unlevels the base of the spine and causes various degrees of scoliosis (improper lateral curves of the spine). The internally rotated leg causes a forward rotation of the pelvis, typically more on the side where the foot hyperpronates the most. The forward rotation of the hips causes changes in the kyphotic (anterior/posterior) curves of the spine and in general causes a forward-leaning, head-forward posture. The compromised posture combined with the torques created by internal leg rotation is often the cause of both joint and muscle pain ranging from knee and hip pain to low and general back pain and shoulder and neck pain, and is also associated with headaches and TMJ dysfunction. Restoring the Morton’s toe to normal function with proprioceptive orthotics can help prevent this predisposition to musculoskeletal problems and alleviate numerous problems of the feet such as Metatarsalgia, hammer toes, bunions, Morton’s Neuroma, Plantar Fasciitis, and general fatigue of the feet.

Morton’s Foot is a relatively uncommon foot condition. And that its reported incidence has been confused with the more common foot structure, Primus Metatarsus Supinatus (Rothbarts) Foot (Rothbart, Podiatry Review.2009).

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